Zionexa has been working with SNMMI to seek proper Medicare reimbursement for Cerianna. As of January 2021, the HOPPS published rate for Cerianna is incorrect. SNMMI and Zionexa are working closely with the Centers of Medicare and Medicaid Services (CMS) to confirm their agreement with our interpretation and to obtain an implementation date. It is our understanding and interpretation of the Redbook AWP and WAC that the correct rate should be $608.33 per millicurie instead of $0.752 per millicurie.
If you are encountering issues with your MAC, please notify SNMMI at email@example.com. CMS has told us that any corrections would be retroactive to January 1, 2021. SNMMI will notify their members and update the Q&As when any corrections are implemented. Unfortunately, we are likely to see corrections at quarterly intervals, so the next is likely to be published in March for April 2021 or July 2021 implementation.
As a reminder, for claims with a date of service January 1, 2021, and beyond (for all payers in all settings), please use A9591 Fluoroestradiol F-18, diagnostic, 1 millicurie.